Card Set Information

2013-01-15 23:14:30
Pharm B1

Show Answers:

  1. Clavulanic acid
    • -Beta-lactamase inhibitor
    • -combined with amoxicillin as Augmentin
    • AE: diarrhea is common, sinisitus

    • -combined with ticarcillin
    • -for severe pseudomonas infection
  2. Sulbactam
    • -Beta-lactamase inhibitor
    • -combined with ampicillin as Unasyn
    • -via IV, IM
  3. Tazobactam
    • -Beta-lactamase inhibitor
    • -combined with piperacillin as Zosyn
    • -via IV
    • -for Pseudomonas infection
  4. Cephalosporins:
    A. about 
    B. generations (4)
    • A. more stable than penicillins to beta
    • B.
    • -1st gen: better G+ activity
    • -2nd gen: better G- activity, but not much
    • -3rd gen: G- rods, some pseudomonas; less active against G+ cocci
    • -4th gen: inc. stability against B-lactamases and more spectrum than 3rd gen.
  5. Cephalexin (Keflex)
    -1st gen. cephalosporin
  6. Cefazolin (Ancef)
    • -1st gen. cephalosporin
    • -IV
    • -used for staph skin infection, soft tissue infection (e.g. furuncle)
    • -for surgical prophylaxis, unless GI/pelvic
  7. Cefoxitin
    • -2nd gen. cephalosporin
    • -works against anaerobes
    • -PO, IV
  8. Ceftriaxone
    • -3rd gen. cephalosporin
    • -for meningitis --> crosses BBB
    • -IV
  9. Cefotaxime
    • -3rd gen. cephalosporin
    • -for meningitis --> crosses BBB-IV
  10. Ceftazidime
    • -3rd gen. cephalosporin
    • -Pseudomonas coverage
  11. Cefoperazone
    • -3rd gen. cephalosporin
    • -Pseudomonas coverage
  12. Cefepime
    • -4th gen. cephalosporin
    • -similar to 3rd gen., but more resistant to hydrolysis by enterobacter beta lactamases
  13. Ceftaroline (Teflaro)
    • -5th gen. cephalosporin
    • -approved for use against multisrug-resistant G+ like MRSA
    • -IV 600mg every 12 hrs
  14. Aztreonam
    • -Monobactam
    • -BIG GUN
    • -resistant to beta lactamases and covers G- rods only!
  15. Carbapenems
    -class of beta-lactamase resistant antibiotics
  16. Imipenem
    • -used w/ Cilastatin to increase efficacy
    • -Broad spectrum BIG GUN
    • -used for complicated infections
    • -AE: seizures
  17. Meropenem
    • -used w/ Cilastatin to increase efficacy
    • -Broad spectrum BIG GUN
    • -similar to Imipenem but less G+ and better pseudomonas; does not penetrate CNS
    • -AE: seizures
  18. Ertapenam (Invanz)
    • -used w/ Cilastatin to increase efficacy
    • -Broad spectrum BIG GUN
    • -used for complicated infections
    • -AE: seizures
  19. Vancomycin
    • -Cell wall inhibitor
    • -BIG GUN
    • -IV & PO
    • -for MRSA sepsis, endocarditis, resistant (PCN) pneumococcal meningitis
    • -AE: fevers, chills, oto/nephrotoxicity, RED MAN Syndrome
  20. Telavancin (Vibativ)
    • -cell wall inhibitor
    • New antibiotic - lipoglycopeptides; synthetic derivative of vancomycin
    • -used for resistant G+ infections
    • -can't be use on VRE (Vancomycin Resistant Enterococcus)
    • -AE similar to vancomycin
  21. Fosfomycin
    • -cell wall inhibitor
    • used for uncomplicated UTI
    • -broad spectrum
    • -PO
    • -AE: diarrhea, nausea, dyspepsia
  22. Chloramphenicol
    • -inhibits protein synthesis
    • -Rarely used except in kids < 8 with severe rickettsial infections (RMSF) and pneumococcal PCN resistant meningitis with major hypersensitivity to PCNs

    -AE: toxic,GRAY BABY SYNDROME, BM suppression and aplastic anemia
  23. Tetracyclines
    • -inhibits protein synthesis
    • -broad spectrum; includes G+ and G-, anaerobes and many others
    • -types: tetracycline, doxycycline, Minocycline
  24. AE of Tetracyclines (7)
    • 1. GI symptoms
    • 2. photosensitivity
    • 3. pregnancy category D
    • 4. hepatotoxicity
    • 5. nephrotoxicity
    • 6. discoloration of teeth and abnormal bone growth in young children
    • 7. vestibular reactions (dizzy and vertigo)
  25. Tygacil (tigecycline)
    -inhibits protein synthesis; first in a new class of antibiotics called glycylyclines 

    -similar to tetracyclines, but designed to overcome

    -approved for complicated intra-abdominal and skin infections that need broad coverage

    -coveres many G+ and G- and anaerobes; option for MRSA skin infections
  26. Azithromycin
    -type of macrolide

    -high penentartion w/ long half-life (40-68 hrs)

    -used to treat chlamydia, acute OM, pharyngitis in PCN allergy, mild CAP
  27. AE of Macrolides (4)
    • 1. epigastric distress
    • 2. metallic taste w/ clarithyromycin
    • 3. cholestatic hepatitis
    • 4. e-mycin and clartithromycin can increase effects of many drugs
  28. Ketek (telithromycin)
    -ketolide class of antibiotics (similar to macrolides)

    -blocks protein synthesis

    -used for CAP

    -AE: N/D, visual disturbance, rarely hepatotoxicity
  29. Dificid (fidaxomicin)
    - used for Clostridium difficile diarrhea

    - Macrolide class

    - very expensive
  30. Clindamycin
    - Macrolide class

    - PO and IV

    for G+ anaerobic bacteria; staph, strep, pneumococcus; NO G-

    - tx of anaerobic and mixed infections (severe); pelvic and abd., abscesses, aspiration pneumonia

    - AE: diarrhea including pseudomembranous colitis, skin rashes, rarely liver rxns
  31. Quinupristin-dalfopristin (Synecid)
    - inhibits protein synthesis, streptogramin tybe

    - treatment for vancomycin resistant straight of E. faecium (VRE) and complciated infections caused by highly resistant staph and strep

    AE: infusion related pain and phlebitis need  to infuse w/ central venous catheter; athralgias and myalgias; CYP 3A4 INHIBITOR SO DI
  32. Linezolid (Zyvox)
    -last resort for treat of VRE and severe infections caused by resistant staph and strep

    -protein synthesis

    -AE: well tolerated w/ minor AE's; monitor platelets in risky pts
  33. Aminoglycosides
    -inhibits proteins synthesis via binding to ribosome

    -bactericidal; synergy w/ beta lactams antibiotics

    -IV, IM only

    -fair penetration into brain and meninges when inflamed; good penetration in renal cortex

    -genamycin, streptomycin, tobramycin, amikacin, netilmicin

    -for severe G- aerobes infection (sepsis, pneumonia, UTI) in combo w/ PCN or cephalosporin
  34. Tobramycin
    -aminoglycoside class

    -more active against Pseudomonas
  35. Streptomycin
    -Aminoglycosides class

    -in combination regimen is 2nd line for TB infections
  36. Amikacin
    -Aminoglycosides class

    -broadest spectrum BIG GUN and may be used for infections resistant to gentamycin and tobramycin
  37. Amingoglycosides AE (2)
    • 1. ototoxicity
    • 2. nephrotoxicity
  38. Spectinomycin
    -similar to aminoglycoside but used for gonococcal infections in PCN allergic pts or resistant gonococcal infections

  39. Sulfonamides and trimethoprim (TMP)
    -sulfonomides used with TMP to produces synergistic blocking of folic acid synthesis

    - oral absorbable & non-absorbable, IV (crosses into CSF), topical (sulfadiazine or silver)

    -spectrum is for G+ and G- agents, some protozoa like pneumocystis and toxoplasma

    -topical agent for conjunctivitis and prevention of infection in burns

    -PO and IV for UTI, PCP, Salmonella, shigella, chronic sinusitis
  40. Sulfa Drugs and TMP other agents (3)
    • 1. sulfazalazine --> non-absorbable
    • 2. oral pyrimethamine and sulfonamide --> toxoplasmosis
    • 3. pyrimethamine and sulfadoxine --> malaria
  41. AE of Sulfa Drugs and TMP (6)
    • 1. allergic reactions (rash, fever, rarely SJS)
    • 2. N/V/D
    • 3. photosensitive
    • 4. granulocytopenia and thrombocytopenia
    • 5. avoid in hemolytic anemic pts
    • 6. pregnancy category C and C/I near end of pregnancy
  42. Fluoroquinolones
    -affect DNA synthesis

    - G negative > G positive aerobic bacteria, including pseudomonas

    -newer agents have better G+ coverage
  43. Fluoroquinolones 1st generation
    nalidixic acid with G- coverage
  44. Fluoroquinololones 2nd generation
    Ciprofloxacin with mostly G- including pseudomnas and little G+
  45. Fluoroquinolones 3rd generation
    • 1. Levofloxacin
    • 2. sparfloxacin (not in US)
    • 3. gatifloxacin

    G- and some G+
  46. Fluoroquinolones 4th generation
    • 1. Gemifloxacin (Factive) NEW! for strep, staph, and atypicals
    • 2. trovafloxacin (gone due to hepatitis)
    • 3. moxifloxacin (avelox)broad spectrum w/ anaerobic coverage
  47. Fluoroquinolones usage (5)
    • 1. UTI esp. Ciprofloxacin; not much w/ 3rd and 4th gen.
    • 2. Gonococcal infections (gonorrhea); increased resistance
    • 3. CAP esp. Levaquin and other 3rd gen.
    • 4. Bacillus anthracis --> Cipro
    • 5. intrabdominal infections (4th gen)
  48. Fluoroquinolones AE (5) and ROE (3)
    • AE
    • 1. N/V but use on empty stomach
    • 2. C/I in pregnancy
    • 3. C/I in age < 18 due to possible dmg to growing cartilage
    • 4. tendonitis
    • 5. CNS disturbances in elderly

    • ROE
    • 1. PO = IV dosing
    • 2. Mostly BID or qd dosing
    • 3. renal elimination
  49. Metronidazole (Flagyl)
    -DNA synthesis inhibitor

    -Useful for parasitic and anaerobic infections

    • -Gold standard PO and IV therapy for anaerobic infections 
    • -amebiasis
    • -giardiasis
    • -trichomoniasis
    • -peudomembranous colitis (c.diff)

    AE: GI intolerance, metallic taste, headache, dark urine, disalfiram-like reaction w/ alcohol
  50. Nitrofurantoin
    • -for UTI
    • -broad activity against urinary pathogens (G+ and G-)

    • AE: anorexia, N/V, rarely hemolysis in G6PD deficiency
    • -chronic use my cause pulmonary hypersensitivity reactions